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Aneurysms of the infrapopliteal region are uncommon. Of them, true aneurysms are very rare and that of the posterior tibial artery (PTA) are extremely rare. We present a case of a 25-year-old female presented with a pulsatile mass behind the right medial malleolus for 1-year duration. Arterial duplex and angiogram revealed a true saccular aneurysm of the PTA. The aneurysm was resected, and the PTA was reconstructed with a reverse saphenous vein graft.